Qkwan Posted June 18, 2011 Share Posted June 18, 2011 Long story short, I took a part-time job in the ED I loved on rotations about 9 months ago. I've made it clear from day one that I would like a full-time position. The last full time position went to another part-timer who had started the same day as me but had significantly more experience. 2 weeks ago, 1 of the 18 SPs tells me how great I am doing and that he's on my side when the next FT position is available. Today, same SP tells me that he doesn't want me to be discouraged when I find out they are giving a FT position to someone else, because they have more experience. I am discouraged because I am the most recent graduate here, so there are a lot of people potentially ahead of me if it's all about experience. He says that's not all it is and again asks me not to be discouraged because I get better all the time and soon I will be someone they can't afford to lose. So, I ask what I can work on to get to that point. He says some of the SPs think I'm overly confident for my education level, then says that he has never seen that in working with me. So, the only thing he can tell me to work on he doesn't even see me do. Needless to say, despite his repeated requests not to be, I am discouraged. And confused. I'm also pleased with the positive feedback and that he took time to tell me personally before I got blindsided with the news by someone else or in an email or something. So, how do I go about not appearing overconfident when I'm already more than willing to get a SP whenever I feel out of my comfort zone, even while I'm on fast-track and the patients are supposed to be "easy"? Thanks in advance for any thoughts/feedback... Link to comment Share on other sites More sharing options...
Guest TerryF Posted June 18, 2011 Share Posted June 18, 2011 I am sort of blunt. I would come right out and ask whoever makes those decisions "What about me?" or "Where do I stand in getting a full-time position?" If it is not in the near future, you may need to move on or settle for part-time work. Just my humble thoughts. Link to comment Share on other sites More sharing options...
physasst Posted June 18, 2011 Share Posted June 18, 2011 Long story short, I took a part-time job in the ED I loved on rotations about 9 months ago. I've made it clear from day one that I would like a full-time position. The last full time position went to another part-timer who had started the same day as me but had significantly more experience.2 weeks ago, 1 of the 18 SPs tells me how great I am doing and that he's on my side when the next FT position is available. Today, same SP tells me that he doesn't want me to be discouraged when I find out they are giving a FT position to someone else, because they have more experience. I am discouraged because I am the most recent graduate here, so there are a lot of people potentially ahead of me if it's all about experience. He says that's not all it is and again asks me not to be discouraged because I get better all the time and soon I will be someone they can't afford to lose. So, I ask what I can work on to get to that point. He says some of the SPs think I'm overly confident for my education level, then says that he has never seen that in working with me. So, the only thing he can tell me to work on he doesn't even see me do. Needless to say, despite his repeated requests not to be, I am discouraged. And confused. I'm also pleased with the positive feedback and that he took time to tell me personally before I got blindsided with the news by someone else or in an email or something. So, how do I go about not appearing overconfident when I'm already more than willing to get a SP whenever I feel out of my comfort zone, even while I'm on fast-track and the patients are supposed to be "easy"? Thanks in advance for any thoughts/feedback... This is actually a more common problem than many realize and something I have encountered in my career as well. It's a double edged sword and a fine line to walk. If you appear overconfident or "cocky" the docs don't trust you. They think you're likely to take on something you shouldn't and will consider you a "cowboy". If you're under confident, or always asking for help, they think you're weak, and question your training and knowledge... It's tough. I actually lost a job once cause I was told that I was too "cocky".....which I am. I personally don't get too focused on it. I've also been told that I am a very "strong" personality..whatever. I am who I am. I find the docs when I need, and I do my own thing 90% of the time. Some docs I know think I am cocky, some appreciate my work ethic, and love working with me. I am a very strong personality, and to some degree, an acquired taste. I've challenged the docs, especially the younger ones when they are doing something I think is overkill, or I don't agree with their treatment. Never in front of patients (that would be VERY unprofessional) but they will definitely know my thoughts. Sometimes they get mad...sometimes they see it my way. I am in a situation now where I am considered the "elder" of the group and leader within the institution....that doesn't mean that I haven't pissed some people off. I know I have. Not deliberately..but it happens. My only advice is that you should try to appear somewhat humble, but strong. I wouldn't try to change your personality. You won't be able to, it will be obvious to everyone around you, and it won't work in the long run. You'll be miserable, you won't be happy, and everyone will know it. Be who you are, and if the job isn't a good fit, then it's not a good fit. My thoughts for whatever little bit they might be worth. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 18, 2011 Moderator Share Posted June 18, 2011 yup, agree with above. same issues with me. I have a "strong personality". some docs like this, some don't. I know the ones who don't and basically avoid them when possible. Link to comment Share on other sites More sharing options...
brookspa Posted June 18, 2011 Share Posted June 18, 2011 anyone else ever been called House? Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 18, 2011 Moderator Share Posted June 18, 2011 I went into an ER and was quickly humbled by my lack of applied knowledge - then along comes a hot shot PA with a LOT less experience and would consistently see 2x's the number of patients I would. She would not even touch patients and way over ordered almost all advanced imaging, all testing, would only rule out MI or CVA, always gave dilaudid to the chronic head ache patients, and was not practicing "productivity standard" medicine. She was the favorite of the doc's as she brown nosed them all a crazy amount. She was in essence made head PA ahead of a whole bunch of other PA's that were nicer, more knowledgable, better clinicins.... you get the picture...... I left after 8 months as I refused to merely turn into a production mill and I was very aware that this ER was sliding down hill. I was the start of the tidal wave of people leaving (PA's and Doc's too) and a large part of it was the influence that this PA had. Why does this apply to you?? She was newish and full of herself and I am sure in her own mind an amazing PA - but she was practicing very substandard medicine and actually injuring her patients (the chronic head ache patients pretty much all got hooked on dilaudid..... turning them into addicts, she repeatedly ordered Abd/Pal CT's on mundane abd discomfort on reproductive age women who were drug seeking - one have ober 7 CT's in a 5 month period for nothing) Be aware of what was really being told to you. If a doc had pulled you aside and spoken to you about your cocky attitude you are likely way out of line and way over confident. I have yet to kill anyone and I remember this when trying to do a quick dispo on a a patient who likely deserves more w/u, and stop and think before ordering another CT about the radiation exposure, and also that even a new ER doc has 4 years of medical school and another 4 of residency at 80hrs/week and you have 3 years of school You can be a great PA, but I can pretty much state that as I new grad in the ER that is being passed over for full time that you attitude is a liability right now and you are not likely all that you think you are. Yes there are PA's on this board that have the right to be cocky and can challenge a Doc (i.e. EMDPA - check out what he has done and the crendentials he holds!) but as a new grad this is not you. sorry to be blunt.... Link to comment Share on other sites More sharing options...
Guest TerryF Posted June 18, 2011 Share Posted June 18, 2011 You can be great or a punk. Until you talk to the boss and find out his/her expectations, evaluation of you, and plan for you, you are flying without a plane. Go and ask what's up and say it outloud, "do you plan on hiring me full-time?". It doesn't matter what business or profession you are in, if you don't know the rules the boss plays by, you can't play the game efficiently. It has little to do with medicine. It deals with personalities and quirks and philosophy and prejudices. Ask, "what's up, doc?". If you don't get a genuine reply, it may be time to move on. On the other hand that person may enlighten you in some areas where he would like to see you improve. You simply can't read people's minds. Remember the words 'talk' and 'conversation'. Link to comment Share on other sites More sharing options...
Guest TerryF Posted June 18, 2011 Share Posted June 18, 2011 PS-----Three things I learned over the years in the military, in sales, in medicine, and in church work. 1. It does not pay to be afraid of the boss. 2. It does not pay to try and second guess the boss. 3. If you are not the 'apple of the boss's eye' or at least one of his/her 'apples', it's time to move on or else learn to be second or last in the boss's eye. Link to comment Share on other sites More sharing options...
andersenpa Posted June 18, 2011 Share Posted June 18, 2011 So, how do I go about not appearing overconfident when I'm already more than willing to get a SP whenever I feel out of my comfort zone, even while I'm on fast-track and the patients are supposed to be "easy"? Confidence is all about being centered in what you know. Even the most seasoned PAs on this forum have knowledge gaps when it comes to certain problems, and they consult/refer. Just as docs do. If you are <1 yr out, your knowledge gaps are significant. As they will be at 2 yrs, and even 3 yrs. Around that point you will likely be able to competently manage the common complaints you see ~80% of your clinical time. It's the other 20% that can bite you, especially when you "feel" like you should "know it by now". The issue may be actually worrying about how confident you appear. You are a new grad. Despite what all new grads think, everyone thinks (appropriately) that you don't know much yet. Cockiness is someone's attempts to fool others into thinking they know more than they do....when others know better. It sounds like experience is what matters at this job. If you really are dedicated to getting a FT position there, keep your head down, ask tons of questions, and work work work. Nobody can fault you for asking questions (remember, nobody expects you to know much- so if you are NOT asking questions than you're flying blind and then they'll really mistrust you). The only problem that can arise is if you keep asking the same questions over and over again and don't seem to "get it". But if you gain knowledge, build it into your own practice style, and do good work, it will (likely) be recognized. And then you will have the experience and respect it appears you need for a FT position. There's no quick fixes, and I doubt magically changing your cockiness is going to score you a FT gig. Slow and steady....... Link to comment Share on other sites More sharing options...
Guest TerryF Posted June 18, 2011 Share Posted June 18, 2011 QKWAN is the problem or somebody else is. If QKWAN is the problem, then he/she needs to fix it. The best way to know how to fix it is to talk to the boss. If QKWAN is NOT the problem, he needs to find out where the problem is. He needs to go to the person who hires and fires and find out. He needs to stop listening to the SPs and see what their boss wants/needs. Confidence is a personality trait that is hard to fake. He needs to be his natural person. If he is confident and up front with people, that is the way he serves his patients. If he is NOT, he can NOT fake that ability. Others pick up on that fast and do not respect it. Confidence is NOT the issue here. The issue is what should QKWAN do NOW. If he wants to work part-time, he needs to do zero/nothing. If he wants to work full-time, he needs to effectively communicate that and find out why he is not being offered that full-time position. This I say to sort of aggravate QWKAN, "perhaps you are the problem. Fess up and find out what is going on." This forum can not tell you what is going on where you work. Neither can the SPs. You need to approach the horse's mouth and be a man/woman and claim your rightful position. OR settle for second best OR move on. Nothing will ever change until you go all the way to the top. Link to comment Share on other sites More sharing options...
VictoriaO Posted June 18, 2011 Share Posted June 18, 2011 I think all upcoming new grads need to give this a read... Great thread, thanks for the contributions everyone. Link to comment Share on other sites More sharing options...
Qkwan Posted June 21, 2011 Author Share Posted June 21, 2011 I appreciate all the input. A few things in response, and if I missed your point I'm sorry. I'm going to try to cover all the issues raised and questions asked. Yes, I am less than a year from graduation. I certainly feel like I know my limitations, and I am not afraid to ask questions if need be even though that is still a lot. I would rather ask a question and feel foolish than harm a patient. I still carry note cards in my lab coat to write down things I am taught at these times so I have them for reference later and I know what I should review on my own so I know more next time. The SPs (there are 18 of them) are my "boss". It is a physician-owned group and they make the decisions. I have had several of them say they wish I was full time. The particular SP I was speaking to in this case had already told me a few weeks ago that the next time a full time position was available he would be "on my side". He took the time to tell me that didn't work out because he didn't want me to be discouraged, said I get better all the time, and that soon they would not be able to afford to lose me. And he's the CEO. So, I do think full time will happen. The full time vs part time thing isn't really my issue right now. They give me more hours than any other part time provider and I actually make more than the full time providers some months. The only real downsides to part time is that the hours aren't guaranteed and no bennies. My confusion was that when I asked for feedback and suggestions for improvement, the only thing he said anyone was concerned about was the overconfidence thing. He did not share which SP(s) feel this way, but did explicitly state that he has not seen me exhibit this problem at all. Since he doesn't see it, I don't see it, and he didn't tell me who does feel that way it's just hard. I do ask SPs for specific feedback, but just get general "you're doing great, thanks for your help today" kind of replies. I do not challenge the SP's treatment plan. If I don't understand the reasoning for something, I ask them to teach me what I am missing so I know for next time or just look it up later if they are too busy for that. Ventana, I know it is dangerous to try to go too fast when you are new and certainly it would be irresponsible to order narcotics and CTs for all patients. That is not how I practice. I work as efficiently as I can, but not at the expense of appropriate patient care. I think the part of the problem may be that with so many doctors and everyone working such varied schedules that while I may have seen (for example) 100+ pregnant women with vaginal bleeding (one of our very common complaints that intimidated me initially but I feel comfortable with now), that doesn't mean the doctor I'm working with today has seen me care for that type of patient more than once or twice if at all. I am going to continue to ask for help when I need it, make sure I am more aware when working with a doctor I haven't worked with much, and learn as much as I can. I certainly know that I didn't go into a profession where studying stopped with graduation. :) Link to comment Share on other sites More sharing options...
Qkwan Posted June 21, 2011 Author Share Posted June 21, 2011 andersenpa~ Thank you. I think your advice was right on. I appreciate it. EMEDPA~ I hope someday I know as much about emergency medicine as you do! everyone~ I know that even when I try to keep it short, it gets long. I apologize, and thanks for reading. I appreciate all the input. Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 22, 2011 Moderator Share Posted June 22, 2011 I appreciate all the input. A few things in response, and if I missed your point I'm sorry. I'm going to try to cover all the issues raised and questions asked. Yes, I am less than a year from graduation. I certainly feel like I know my limitations, and I am not afraid to ask questions if need be even though that is still a lot. I would rather ask a question and feel foolish than harm a patient. I still carry note cards in my lab coat to write down things I am taught at these times so I have them for reference later and I know what I should review on my own so I know more next time. The SPs (there are 18 of them) are my "boss". It is a physician-owned group and they make the decisions. I have had several of them say they wish I was full time. The particular SP I was speaking to in this case had already told me a few weeks ago that the next time a full time position was available he would be "on my side". He took the time to tell me that didn't work out because he didn't want me to be discouraged, said I get better all the time, and that soon they would not be able to afford to lose me. And he's the CEO. So, I do think full time will happen. The full time vs part time thing isn't really my issue right now. They give me more hours than any other part time provider and I actually make more than the full time providers some months. The only real downsides to part time is that the hours aren't guaranteed and no bennies. My confusion was that when I asked for feedback and suggestions for improvement, the only thing he said anyone was concerned about was the overconfidence thing. He did not share which SP(s) feel this way, but did explicitly state that he has not seen me exhibit this problem at all. Since he doesn't see it, I don't see it, and he didn't tell me who does feel that way it's just hard. I do ask SPs for specific feedback, but just get general "you're doing great, thanks for your help today" kind of replies. I do not challenge the SP's treatment plan. If I don't understand the reasoning for something, I ask them to teach me what I am missing so I know for next time or just look it up later if they are too busy for that. Ventana, I know it is dangerous to try to go too fast when you are new and certainly it would be irresponsible to order narcotics and CTs for all patients. That is not how I practice. I work as efficiently as I can, but not at the expense of appropriate patient care. I think the part of the problem may be that with so many doctors and everyone working such varied schedules that while I may have seen (for example) 100+ pregnant women with vaginal bleeding (one of our very common complaints that intimidated me initially but I feel comfortable with now), that doesn't mean the doctor I'm working with today has seen me care for that type of patient more than once or twice if at all. I am going to continue to ask for help when I need it, make sure I am more aware when working with a doctor I haven't worked with much, and learn as much as I can. I certainly know that I didn't go into a profession where studying stopped with graduation. :) excellent well thought out response - hang in there - sometimes things just take time..... Link to comment Share on other sites More sharing options...
Qkwan Posted June 23, 2011 Author Share Posted June 23, 2011 Thank you. Link to comment Share on other sites More sharing options...
Evan Posted June 23, 2011 Share Posted June 23, 2011 Early on in my medical career, pre-pa days, I had a part time gig where I had been a student and where the manager had "promised" to consider me for a full time position. Long story short, 2 full time opportunities came and went to others. I was (IMHO) justifiably upset. I met with the manager and he, once again, promised to consider me the next time a position came around. He was not really able to give me good feedback and couldn't (or wouldn't) tell me areas to improve. I needed the cash and I was volunteering for every extra shift that came along. Essentially I was working full time hours without the benefits or stable schedule of an actual full time gig. When I mentioned this to a friend (mentor) he suggested that I was being used for my (decent) skills and agreeable (flexable) attitude. If they offered me a full time position they couldn't use me to fill hard-to-staff shifts (nights, weekends, holidays, unexpected call-offs). I made the decision at that point to move on. Sometimes it is better to start fresh in a place that didn't know you as a student or as a "new grad". Even in this economy there are still jobs out there to be had. Don't limit yourself, you may actually like another facility or group better than your current gig. Just my 0.02... Good Luck... Link to comment Share on other sites More sharing options...
Qkwan Posted June 26, 2011 Author Share Posted June 26, 2011 Some very good points. I'm going to have to think about that some more... Thanks. Link to comment Share on other sites More sharing options...
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